Social disparities in the use of diagnostic tests for children with gastroenteritis.
OBJECTIVE
To determine whether patient demographic characteristics affect the use of diagnostic tests for the evaluation of children with acute gastroenteritis by emergency department (ED) physicians.


METHODS
Retrospective chart review.


METHODS
Emergency department of a tertiary care pediatric hospital.


METHODS
All patients seen in the emergency department over a six-month period with a discharge diagnosis of acute gastroenteritis (GE) as identified through a computerized patient log (n = 503).


METHODS
Sociodemographic characteristics ("race" and insurance) were obtained from computerized hospital data. The number of tests ordered was identified from the medical records, as were indicators of illness severity. We utilized multivariate logistic regression using the generalized estimating equations (GEE) model to account for repeated visits and adjust for potential confounding.


RESULTS
Hispanic children were less likely to undergo more than two tests [OR.53 (95% CI.31,.92)] or have an X-ray done [OR.31 (95% CI 0.15, 0.67)], after adjustment for age and disease characteristics. Self-pay patients were less likely to have a test performed [OR.53 (95% CI.3,.96)].


CONCLUSIONS
Some patient social characteristics remain associated with differing patterns of use of diagnostic tests for a common pediatric condition. Although this study provides no information on patient outcome, health providers should strive to reduce differences in care based on patient social and economic factors as distinct from characteristics of the patient's condition or medical need.
Quintana
J M
JM
Department of Quality Improvement and Hospital Epidemiology, Children's Hospital, Boston, MA 02115, USA.
Goldmann
D
D
Homer
C
C
D000208:Acute Disease; D000704:Analysis of Variance; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D017057:Medically Uninsured; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011287:Prejudice; D012720:Severity of Illness Index; D012959:Socioeconomic Factors